Showing posts with label public policy. Show all posts
Showing posts with label public policy. Show all posts

Racism is not a Mental Illness; Racism is a Sin

  • Racism is not a mental illness; racism is a sin.
  • White nationalism is not a mental illness; white nationalism is a sin.
  • Violence is not a mental illness; violence is a sin.
  • Hatred is not a mental illness; hatred is a sin.

Okay, the Christian in me is coming out here when I say sin. And even some Christians have trouble using that word these days. Which is fine. Don't use it if you can't sort out sin from all the baggage it carries.

But for the love of God and your neighbor, don't substitute mental illness to explain the appalling image of the latest white guy with his racist manifesto and his swastika painted on his semiautomatic weapon shooting up the Dollar General, or the supermarket, or the bible study.

Use the word wrong if you can't bring yourself to say sin. Wrong doesn't seem strong enough, I understand that. But explaining these events as mental illness is REALLY wrong on two levels.

Ignoring the Evidence about Mental Illness

First, mental illness does not correlate with violence.

Let me say it again for the people in the back of the room.

Mental illness does not correlate with violence.

Sure, journalists will go digging into the background of the latest shooter. And journalists will find that the shooter had some previous contact with mental health services. The American Journal of Public Health article by Sherry Glied and Richard G. Frank explains this phenomenon:

The journalist’s search for a mental illness explanation of aberrant acts will almost always succeed. Epidemiological research suggests that nearly half the population—whether or not involved in crime—experience some symptoms of mental illness over the course of their lifetimes. The most recent population estimate of the lifetime prevalence of major mental illnesses meeting diagnostic criteria among US adults is 46%, and 9% meet criteria for a personality disorder. Seeking mental health treatment is hardly less common: the literature suggests that about one fifth of the US population report seeking professional care for a mental health problem in a year and nearly one third do so over their lifetimes. 

The very high lifetime prevalence of illness and treatment seeking helps explain why virtually every story of a violent act can be linked to some clues of psychological abnormality or mental health treatment—even though the rate of violent behavior of any type among people who meet diagnostic criteria for mental illnesses is estimated to be only about twice as high as the rate among those who never experience a mental illness. Mental illness is simply not a very specific predictor of violence.

People with serious mental illness are only twice as likely to commit violence than the general population. Which means that they commit 4% of violent crime. 4%.

It is wrong, it is incorrect to explain violence by mental illness.

Why does the myth persist, contrary to the evidence? Because having rejected the concept of sin, we can't figure out why these things happen, unless something is wrong with their heads. But that explanation is wrong, as in incorrect.

Indeed, there is something wrong in their heads. But it is not mental illness.

  • Racism is not a mental illness.
  • White nationalism is not a mental illness.
  • Violence is not a mental illness.
  • Hatred is not a mental illness.
Which is why, when these guys are taken in for evaluation, they are released. Because they are not mentally ill.

Making Mental Illness Illegal

Blaming mental illness for violence is wrong in a second way. It is harmful, hateful, and dangerous.

Harmful, hateful, and dangerous.

Liberals repeat the myth of violence caused by mental illness to support funding for more services for the mentally ill (which never are forthcoming). Conservatives repeat the myth to push back against gun control (without allowing any restrictions, even for those they claim to be violent). Both liberals and conservatives, both liberals and conservatives create scapegoats of vulnerable people.

Here is what a candidate for president of the United States tweeted, repeating his answer to the violence question in the recent GOP debate:

Don’t remove guns from law-abiding citizens. Remove violent, psychiatrically deranged people from their communities and be willing to involuntarily commit them. Revive mental health institutions: less reliance on pharmaceuticals, more reliance on faith-based approaches that restore purpose to people’s lives. We know from the 1990s how to stop violent crime. The real question is if we have the spine to do it.

That this candidate has low polling numbers does not undo the damage he does by calling us violent and deranged. He makes such discourse seem reasonable.

On the other end of the political spectrum, both California and New York City politicians are endorsing forced institutionalization and treatment of people with serious mental illness, even for those who do not pose an immanent threat to themselves or others.

Forced institutionalization may look like compassion. It is a violation of civil liberties. It makes mental illness illegal.

Where will these forcibly institutionalized people be housed? The latest figures for all types of psychiatric inpatient settings are from 2014, when there were 170,000 beds available. However, that figure includes VA and private hospitals. State capacity, where those who are hospitalized by the state go, is 35,000 beds.

Where are the mentally ill really housed? According to a recently released federal Bureau of Justice Statistics (BJS) report, 1.25 million of them are in prison, where they do not fare well. According to this report:

Prisoners with mental illness find it more difficult to adhere to prison rules and to cope with the stresses of confinement, as evidenced by the new BJS statistics that 58 percent of state prisoners with mental problems have been charged with violating prison rules, compared to 43 percent without mental problems. An estimated 24 percent with a mental health problem have been charged with a physical or verbal assault on prison staff, compared to 14 percent of those without. One in five state prisoners with mental health problems has been injured in a fight in prison, compared to one in 10 of those without.

Prison staff often punish mentally ill offenders for symptoms of their illness, such as being noisy, refusing orders, self mutilating or even attempting suicide. Mentally ill prisoners are thus more likely than others to end up housed in especially harsh conditions, including isolation, that can push them over the edge into acute psychosis.

The Bigger Picture - Making Homelessness Illegal

“The man standing all day on the street across from the building he was evicted from 25 years ago waiting to be let in; the shadow boxer on the street corner in Midtown, mumbling to himself as he jabs at an invisible adversary; the unresponsive man unable to get off the train at the end of the line without assistance from our mobile crisis team: These New Yorkers and hundreds of others like them are in urgent need of treatment and often refuse it when offered,” the mayor said.

...Mr. Adams has received criticism from some progressive members of his party for clearing homeless encampments and for continuing to push for changes to bail reform that would make it easier to keep people in jail. The mayor has defended his focus on public safety and has argued that many New Yorkers do not feel safe, particularly in Black and Latino neighborhoods.

Connect the dots. From homeless to mentally ill to dangerous to better off incarcerated, one way or the other.

The Myth Will Not Make You Safe

My friends, you can put another 1.25 million of us loonies in jail. That young man will still be stalking the streets who lives with his white middle class parents in their suburban home with an arsenal in the basement. You will have done nothing to protect our schools, our shopping centers, and our bible studies.

So stop it.

Racism is not a mental illness; racism is a sin.

Bad Mental Health Take on Autism - One More from Allen Frances

Before Mental Health Awareness Month draws to its nonconsequential end -- 

Allen Frances

New York Post has published a new interview with Allen Frances about how bad it is to receive a diagnosis, or as he puts it, become a mental patient.

Become a mental patient?

Some background: Allen Frances is a professor emeritus of psychiatry and behavioral sciences at Duke University. His fields of research were wide ranging, including personality disorders, chronic depression, anxiety disorders, schizophrenia, AIDS, and psychotherapy. [Note: not autism]. He served as the chair for the DSM (Diagnostic and Statistical Manual of Mental Disorders) task force, which published the DSM IV in 1994. He later became the chief critic of the DSM 5, which is a modest revision of his work.

In a nutshell--he didn't like any of the revisions.

As part of Frances's critique of the DSM 5, he wrote Saving Normal, subtitled An Insider's Revolt against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. His book was published one week before the DSM-5. Since then he has continued the themes of the subtitle.

In addition to my review of his book linked above, I have commented a few times on Frances's statements. I appreciate his concerns about Big Pharma's influence in the treatment of mental illness and inappropriate use of medication, especially in the case of mild depression. His periodic attempts to save normal, not so much.

A couple quotes from his New York Post interview:

Dr. Allen Frances told The Post that he is “very sorry for helping to lower the diagnosis bar.”

Now, Frances said, he fears his work “contributed to the creation of diagnostic fads that resulted in the massive over-diagnosis of autistic disorders in children and adults.”

Stigma Against Mental Illness

One of the themes of Saving Normal is that diagnosis exposes people to stigma. So it would be worrisome to him that so many people are now mental patients, newly exposed to stigma.

I'll grant Francis this point. Prejudice against mental illness is alive and well - and particularly dangerous when it is expressed in the medical field.

There is scant evidence that Stamp Out Stigma campaigns have moved the needle, except on the issue of depression. Judging by news reports, prejudice against people with mental illness has been growing. 

  • Recently, an ex-Marine is lauded as a hero after putting Jordan Neely, a disturbed man on a New York subway, into a choke hold for fifteen minutes. In two days Daniel Penny raised over $1.5 million for his defense against a charge of second degree manslaughter.
  • As politicians regularly blame mass shootings on mental illness, they also routinely reduce funding to address it.


The thing is, prejudice against difference does not stem from diagnosis. It stems simply from difference itself.

A Diagnosis of Autism

In the case of autism, let me suggest an alternative to Francis's view.

From the anecdotal evidence of many people finally diagnosed in adulthood, the diagnosis brings not stigma but relief. They had already been stigmatized throughout childhood. Not by a psychiatric diagnosis, but by the schoolyard diagnosis weird and the classroom diagnosis behavior problem. They grew up being bullied and punished because they were not normal - to use Dr. Francis's favorite word.

People diagnosed with autism in adulthood often already have other diagnoses, most commonly depression and anxiety. They sometimes have experienced suicidal thoughts or attempts. These are the consequences not of their undisclosed diagnosis of autism, but of the way they have been treated by others - on the basis of their difference which it does not take a psychiatrist to notice. It only takes a psychiatrist to explain.

Hence their relief - finally to have an explanation.

The NYP quotes the statistic that rates of autism in the US have soared 500% over the last sixteen years. This is a bait and switch statistic. The DSM 5 changed the definition of autism, combining profound autism, childhood disintegrative disorder, pervasive developmental disorder, and what was once called Asperger syndrome under one umbrella diagnosis, autism spectrum.

Whether or not combining these conditions with different treatment needs under one label was a good idea is a separate discussion. But the change in rates was not as drastic as the statistic suggests. The numbers for three separate diagnoses have been added to the first.

But it is not the first time Dr. Francis has played fast and loose with statistics to claim over-diagnosis. The statistic does not support his thesis of over-diagnosis because the sample population has changed.

Underserved Children with Autism


The article misses the most significant part of the story, reported in the journal Pediatrics. There are significant disparities in rates of diagnosis between white and black children and between affluent and poor children:

Black children were 30% less likely to be identified with ASD-N compared with white children. Children residing in affluent areas were 80% more likely to be identified with ASD-N compared with children in underserved areas.

The consequence of under-diagnosis is that, while rich white kids get services, poor black kids get placed in the school to prison pipeline.

There are real life consequences to under-diagnosis. Poor black kids should not have to pay the cost for Allen Frances's hobby horse.

More Next Week


So clearly, I have thoughts. Lots of thoughts. It's time to sign off for this week and promise more to come. But you are welcome to join the conversation by commenting below!

What Happened When Meghan Markle Asked for Help?


Ask for help. That is the suicide prevention message. When you are in trouble, ask for help.

And I am not going to suggest otherwise. That's about the only way you will get help. The pain that you are in, the scary thoughts that you are having, there is a way out that is a way through, that leaves you alive on the other side. The way begins when you tell somebody, when you ask for help.

That, alas, is not the end of the story. This week we watched as a princess, a celebrity, somebody who lived in a multimillion dollar house in a multibillionaire family told her story of what happened when she asked for help.

They told her, No.

Will This Trauma Never End?

I found this video while trying to survive the cluster f*ck of misdiagnosis, antidepressants, mixed episodes, and a psychiatrist and therapist who didn't know what they didn't know, so it must be me and maybe I had borderline personality disorder - the go to diagnosis for patients that the professionals are tired of.

OK Go - This Too Shall Pass. And in fact, it did. I survived to... today? I offer it to everybody who is trying to survive the current COVID cluster f*ck in the US.

Pride Month Report: What Parents Can Do for Their Trans Daughters and Sons


1.8 million LBGTQ youth (13-24) in the US seriously consider suicide each year. The numbers for trans people in particular are even more staggering. According to the UCLA Williams Institute report, 81.7 percent of those surveyed by the National Center for Transgender Equality had seriously thought about killing themselves in their lifetimes, and 48.3 percent had done so in the last year. 40.4 percent of transgender people attempted suicide sometime in their lifetime.

Suicide happens when pain exceeds resources for coping with pain. This report adds evidence to that assertion. The following statistics are pulled directly and paraphrased or quoted from this report.

Mental Health Innovators Ponder the End of the COVID-19 Honeymoon

Dear Mental Health Innovators: The COVID-19 Honeymoon Is Almost Over.

The title of a recent PsychiatricTimes.com article caught my eye. Honeymoon? Then I realized it was dated May 19, so perhaps the authors could rewrite the title with the "Almost" removed.

The authors identify predictable stages of psychological response to our current pandemic. Unbeknownst to those whose education was really less education and more training for their future jobs (so things like history were deemed a waste of time), the human family has lived through past disasters, including multiple pandemics. There are patterns to these things.

Heroic Stage

Misconceptions about Suicidal Thoughts

My publicist seems to think people have a lot of misconceptions about mental illness (she's right), because many of her questions go there. You are very open about discussing your own struggles with suicidal thoughts. What do you think are the biggest misconceptions about people going through similar experiences? So today's post will focus on suicidal thoughts or suicidality.

Suicide is not a choice


The way people talk, you'd think we sit down and make a list, pros and cons of suicide. Then based on our calculations, we make some kind of decision. She chose to end her life. Or, How could he have been so selfish.

This is called the volitional theory of suicide, suicide as an act of will. The suicide prevention approach that addresses it is to weigh in on that list of pros and cons, like Jennifer Michael Hecht's book, Stay.

You know -- Suicide is a permanent solution to a temporary problem. Or, Think of what you'll miss out on. Or, whatever. In other words, how dumb or short-sighted or irresponsible or selfish you must be to decide to kill yourself.

A Common Struggle - A Review

In A Common Struggle, Patrick Kennedy tells the story that only he can tell.

There are many memoirs of depression, bipolar, co-morbid substance abuse, families that keep secrets, and recovery. Lately there are memoirs that combine a personal story with a cause: get help, get the right diagnosis, find people who can support you, advocate for better treatment.

Kennedy's unique perspective is the insider's view on the long-term national political work of improving mental health care.

Mental Health Care as our Institutions Fail

There are twelve psychiatrists in Zimbabwe for a population of 16 million people. When Dixon Chibanda, one of the twelve lost a patient to suicide because she could not afford the $15 bus fare to get to her appointment, he did not blame her for breaking the appointment. He came up with another system to deliver mental health care. He trained grandmothers.



Physician-Assisted Suicide for Mental Illness - It's Complicated, or Not

Two years ago, Mark Komrad attended and presented at a symposium in Belgium on physician-assisted suicide for people with mental illness. Komrad is a clinical psychiatrist, ethicist, and faculty member at Johns Hopkins. He just finished a 6-year tenure on the APA Ethics Committee and helped craft the current APA position on Medical Euthanasia for non-terminally ill patients. [That position joins the AMA to say, in a word, Don't.]

Komrad reported back on his experiences to PsychiatricTimes.com. You can read or listen to the his entire report here. This post quotes the parts that particularly struck me from a suicide prevention perspective.

In 2002 Belgium legalized euthanasia by physician (typically by injection) at the request of patients, and removed any distinctions between terminal vs. nonterminal illness, and physical vs. psychological suffering. As long as the condition is deemed "untreatable" and "insufferable," a psychiatric patient can be potentially eligible for euthanasia. There is a consultative process that basically needs a minimum of two doctors to agree about the patient's eligibility. Also, the patient gets to weigh-in on whether their condition is "treatable." Since the patient has the option to refuse treatments, this refusal may create an "untreatable" situation.

Doctors as Priests, Providers and Protectors - Part 4

In Priests, Providers, and Protectors: The Three Faces of  the PhysicianRon Pies proposes a third way to view physicians, not exalting them to the grandiose position of Priest nor demoting them to mere Provider. In the role I call the Protector, the physician's chief obligation is that of  the safeguarding of the patient's physical, emotional, and spiritual well being.

This is a role that acknowledges the patient's autonomy, while recognizing the physician's expertise and the ethical imperative to use that expertise to express foundational principles of the medical field: beneficence, nonmaleficense, and justice. Do good, don't do harm, and I'm not sure what he means by justice, though I have some ideas. The examples below are mine, not his.

Silence Kills -- The Stigma of Mental Illness Redux

It's Mental Health Month again. Out comes the stigma word, the pleas for understanding, the heart-warming whatever.

I am so done with stigma. Frankly, I am insulted that NAMI et al still use the word. Is Black Lives Matter about stigma?  It's dangerous to be either in the US, and for the same reason. Prejudice, people. We are talking about prejudice.

The following was first posted in July 2013. Alas, we are still trying to get our heads out of our asses. The Affordable Care Act made some progress, a little, toward mental health parity. Insurers had to get creative to deny us coverage. But this congressional session, it's all up for grabs again, whether our illness will get covered at all. And the prejudice of doctors -- don't get me started.

So from July, 2013 --

                              *************************

I don't use the s-word. I hate this title. I use it only because people who need this post will use it when they google.

I don't use the s-word. But here it is.

First from Google:

Definition of STIGMA

Noun
  1. A mark of disgrace associated with a particular circumstance, quality, or person: <the stigma of mental disorder>.


Soldiers on Psych Meds

Lies, damn lies and statistics. -- It's a mantra used by people who don't accept the conclusions somebody else draws from statistics.  Today it is my mantra.

Here is a statistic:  Since 2005 there has been a remarkable eightfold increase in psychiatric prescriptions among our active duty troops.  An incredible 110,000 soldiers are now taking at least one psychotropic drug, many are on more than one, and hundreds die every year from accidental overdoses.

Saving Normal: Here I Go Again

Allen Frances uses this statistic (and I do not dispute the fact) in support of his contention, that normal people are being misdiagnosed, and hence overmedicated for mental illness.  The suggestion is that normal soldiers are put on dangerous psychotropic medications that they do not need.

Well, let's put to one side the implied accusation of nefarious, or at least incompetent conduct by medics and their commanders, and instead look at some facts.

Michael Hill and Antoinette Tuff: Lesson in Crisis Intervention

On August 20, 2013, at the Ronald E. McNair Discovery Learning Center in Decatur, Georgia
                       -- nobody died.

Tuesday, the first school shooting of the new school year

                       -- didn't happen.

It started the way these things start.  A disturbed young man went off his meds.  He decided he would die that day.  He did what others have done who wanted to die.

Suicide By Cop

Saving Normal - At What Cost?

Rest In Peace, John Ferguson

John Ferguson was executed by the State of Florida on Monday, August 5 at 6:17 p.m. ET.  He killed eight people thirty years ago, and many people can't get too excited about his own death.  I understand that.  As a Christian, I am grieved that my nation kills people to show that killing people is wrong.  But I get it.

The civilized world does not get it.  The United States of America is a member of an elite club, forty-three nations that have executed people in the last ten years (brown in the map below, along with China, Syria, Libya, North Korea -- our good buddies, all of them).  We bear the distinction of being the only member from among the developed nations.


We do place limitations on the death penalty.  Our constitution, since its first passage, prohibits cruel and unusual punishment, the eighth amendment.  Over the years, the Supreme Court has ruled that all forms execution are cruel and unusual, except for lethal injection, the method that Florida used to kill John.

American Medical Association on the Death Penalty

Silence Kills - The Stigma of Mental Illness

I don't use the s-word.  I hate this title.  I use it only because people who need this post will use it when they google.

I don't use the s-word.  But here it is.

First from Google:

Definition of STIGMA

Noun
  1. A mark of disgrace associated with a particular circumstance, quality, or person: <the stigma of mental disorder>.

Rx for Joy - Joanne Shortell

Joanne Shortell took me up on my call for guest bloggers.  I am glad she did, as I learned of a blogger and mental health advocate I'd like to introduce to you.  Joanne has three websites.  Strongly Bipolar is a blog similar to Prozac Monologues.  Maevetour.blogspot.com/ is the source of the following piece.  And Servicepoodle.com gives more information about the issue it discusses.  

Rx for Joy Can Be Written by any Therapist in the U.S.


My current therapist is a nurse practitioner who can prescribe psychiatric drugs.  My previous therapist was an MSW who could not.  Both, however, could write a prescription for an emotional support animal (ESA).  A short, simple letter (see sample below) from a doctor (any medical doctor, not just a psychiatrist) or any therapist will allow a person with a psychiatric disability or a chronic pain condition to have pets in no-pets housing, to avoid any pet deposit or pet fee, and to avoid size limitations or species restrictions.  The person with the disability gives this to their landlord or co-op/condo board as a request for a reasonable accommodation.  (See link: How to Get an Emotional Support Animal.

Why should I prescribe ESAs?

Thomas Insel - Toward a New Understanding of Mental Illness




Cutting this guy's budget is like telling Orville and Wilbur Wright to take the month off.

We Are On Our Own


Last week I was part of a group that was confronted with a psychiatric crisis in a visitor.  This group had never been called upon in this way.  But among our ranks we had enough experience of psychiatric crisis that:


1) We were determined we would help a stranger; and
2) We knew how to do it.

Part of the story was that inevitable series of telephone calls to offices in 24 hour institutions that were closed.  When flesh and blood was finally located, the response was rude, ineffective and dismissive.

When I debriefed with my therapist, she expected my frustration at calls for help that did not yield help.  That is one of my therapy themes -- a cognitive schema, as a former cognitive therapist called it.  I surprised my new therapist and surprised myself with my response.  No, I didn't expect help.  We are on our own.

Defending DSM-5 -- Sort Of

Good mental health reporting takes research, careful analysis, nuance and a whole lot of work.  And in the end, it doesn't sell newspapers.  Which is why you see so much bad mental health reporting, even where you thought you'd find better.


[I like to think that opening sentence explains why I post no more often than once a week.  I work to provide a quality product.  But that is for you to judge.]

The long awaited publication of the Diagnostic and Statistical Manual, Edition V has generated a blizzard of easy-to-whip-off articles with sensationalist headlines, just the thing for you to share on Facebook on a boring weekday afternoon, and get a nice Ain't it awful rant going among your friends when, really, you should be doing your life.

The Spectre of the Butterfly Net

Most of these articles follow the same tired theme, Psychiatrists are out to diagnose half the population, turning normal human conditions into mental illnesses, because they are in cahoots with the pharmaceutical industry to put the nation on medication.

These articles write themselves.  Pick any diagnosis that the DSM-V has dared to update from a work last revised nineteen years ago, add a quote from the disgruntled old man who was editor-in-chief of said nineteen-year-old document, which only barely tinkered with the 1980 edition anyway, plug in a statistic on drug sales, and there you have it.

Next, pick another diagnosis, substitute a humanistic psychologist for the disgruntled old man, and you are good to go with next week's article.

I, who love links, am not going to link to any of this trash.

Now I have my problems with the DSM.  But I do have some sympathy for its revisers, caught in the middle of a sea change, trying to update a system that will be tossed into the deep within the decade, and would have been already, if we spent any halfway reasonable amount of money on research.

For now I will do my own op ed piece and offer for your consideration the following assertion, based on my own experience in the system and reports of friends who have been at this a whole lot longer:

There are no psychiatrists running around on the streets, chasing toddlers with temper tantrums, trolling funeral parlors for grieving widows, whipping up business.  People!  There are not enough psychiatrists to deal with the loonies already identified.  They do not need you!

You don't get to see a psychiatrist and submit to trial by DSM until

  • denial
  • snapping out of it
  • hiding
  • behavioral modification
  • herbal remedies
  • and prayer

have not worked, and there is no choice but to go where you do not want to go, in the face of your drinking buddies who all tell you, You'd have to be crazy to see a psychiatrist.

Well, maybe you are.  Maybe you are on the knife's edge.  Be prepared to stay there a while longer.  It will take three months to get an appointment.  Longer, if you don't have insurance.

Seriously, they don't need you.

Diagnosis is Your Best Friend

Do you know anybody who has suffered for years with some unidentified illness, bouncing from doctor to doctor, treatment plan to treatment plan, feeling crazy and out of control, because there is no reasonable explanation for these vague, though debilitating symptoms that come and go, and your friend begins to think that you all think he/she is crazy and not really sick at all?  Lyme Disease, Fibromyalgia, TBI, MS, ALS, Lewy Bodys...

The day that person receives a diagnosis, even a difficult one, is a day of rejoicing.  Now he/she knows, can make plans, can learn about the illness, follow a course of treatment, maybe even find one that helps.

Diagnosis, if it is the right diagnosis, even if it is more serious than the previous diagnosis, even if you really, really don't like the diagnosis, is the first step toward recovery.

I mean, think about it.  If you get out of breath climbing a flight of stairs, do you listen to your friends tell you to rest mid-flight?  Or do you go to a doctor who might tell you that you have a blocked artery?  Is the doctor drumming up business?  Or is he/she saving your life?

Mental Illnesses are Made of Normal Experiences

Let's break out some dialectical thinking.  I know, it's hard.  That is why mental health reporters for USAToday and even the New York Times don't ask you to do it.  Prozac Monologues does ask you to do it.  But we can take it slow.

First, what is dialectical thinking?  It is when you hold two truths that seem to contradict each other in your mind at the same time.  Truth is not about either/or.  It is mostly both/and.

So our first statement is this:

Mental illnesses are made of normal experiences.  Everybody gets sad.  Everybody gets angry.  Everybody gets up in the morning sometimes and just can't get started on the day.  Everybody who walks by a group of scary people thinks they are saying bad things.  Everybody catches something out of the corner of the eye that isn't really there.  Everybody throws something against the wall.  Everybody persists in believing something that is false.  Everybody has an occasional impulse to jump off the bridge.

The symptom lists of the DSM are filled with behaviors that everybody does.

News Flash:  Us loonies inhabit the same planet as everybody else.

That is the first truth in our venture into dialectical thinking.  And it is the source of all those headlines about how the DSM is turning normal behavior into mental illness.  How is this for a thought -- mental illness really is not that weird after all.

The Suffering of Mental Illnesses is not Normal Suffering

But.  Here is the other statement to hold in your mind while remembering the first one:

There is a difference.  You get a diagnosis of some sort of mental illness when a whole lot of normal experiences and a whole lot of normal suffering pile up beyond your ability to function in a normal world.

That's it.  If you are not at the end of your rope, you do not have a mental illness.  Rather you are having a bad day, or week, or year.  If you are functioning well in the world, you do not make an appointment with a psychiatrist, and do not receive a diagnosis.  And the psychiatrist is just fine with that, because he/she doesn't have time to see you anyway.  The DSM is not about you, and does not try to be about you.  So leave it alone and let it help those of us who need its help.

When your loved one dies, you will not be diagnosed with depression just because you are going through a normal grieving process.  A normal grieving process looks like depression, but only on the surface.

If what you have is Major Depressive Disorder, then you don't go through a normal grieving process.  You don't think about your loved one; you don't remember the good times; you don't share those scandalously funny pokes in the ribs during the funeral; you don't cling to your sister; you don't even get mad at the person who deserted you by dying.  You just sit under a black cloud and think about how miserable you are.  So you do not get better, and -- get this -- you do not do normal grieving, until you get treated for your depression.

Grieving widows are in no danger from the DSM, if their grieving really is normal.

When your child throws a temper tantrum, you don't run out for a diagnosis of Disruptive Mood Dysregulation Disorder.  A badly behaved child has good days and bad days.  If the parents are consulting with school and other resources and genuinely working on the issue, things get better.  When they have tried every recommendation in the book, when they fear for their lives, when the child is out of control and scared and miserable about his/her own behavior, and this has gone on for years...

then it is insulting, it is cruel and it is simply not helpful to tell these parents that there is nothing wrong with their child and that the doctor's attempts to figure it out are part of some grand conspiracy that threatens to medicalize normal behavior.  If you don't know, if you have not walked in their shoes, then shut the hell up.

Naughty children are not diagnosed in the DSM, if they can get better without it.

Diagnosis of Mental Illness is Not Easy

The DSM V does not make diagnosis easier.   Yeah, well -- diagnosis of any sort got more complicated when they threw over the four humours theory.

There is more to say in the DSM's defense.  I will get to it.  It will make me work and make you think.  And I don't imagine you will share it on Facebook.

Oh well.  My ad revenue never did pay the mortgage.

flair from Facebook.com

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